Unwelcome Guest, Unwilling Host
How to deal with [and mentally ditch] the most unwelcome of guests.

By Brian Stabler, PhD

I used to think of cancer as a badly behaved, uninvited guest who ran up all kinds of unexpected bills and expenses for its unwilling host. Here’s a thought about a way I believe one might resolve this issue—talk to yourself.

Sound stupid? Take a minute to see if I can make sense of this for you. Learn to talk to yourself. And be sure to listen well, because you may find you are a lot smarter than you think.

10 things patients who “host” cancer love to hear their doctor say:

1. Your CT is clear. See you next year.
   
2. You are ahead of the treatment response curve.
   
3. You are an amazing person.
   
4. I don’t see any reason for further treatment.
   
5. We’ll let you show us what works best for you.
   
6. Your family is a good tonic for you.
   
7. If you don’t believe me, just look in the mirror.
   
8. Sometimes miracles do happen, don’t they?
   
9. You remind me of a patient I knew a long time ago. She called me yesterday just to chat.
   
10. Looks like you got it licked! What wonderfully delicious words for a cancer patient to hear—so welcome, heartening, thrilling and easy to listen to. Not always what you might actually hear though.

Learning to Hear

When I first came to meet cancer, I literally could not hear. I thought I had become deaf as my doctor tried to explain to me that I had lymphoma. He phoned me with results from blood tests. I took his call while pacing nervously around my living room holding a cordless phone.

“What’s that?” I croaked through parched lips. “You say I’ve got a ‘lipoma?’” I can see myself now, wearing bright green and orange bathing shorts and a Carolina Blue T-shirt, hopping around between pieces of furniture as if being chased by a rabid raccoon. In the process, I stepped on the cat, knocked over an Egyptian vase full of large billowing ostrich feathers, and twice lost phone contact because I walked outside.

Not only did I look comical, but my conversation with the doctor was rapidly going downhill as I struggled to hear, absorb and comprehend the enormity of what he was saying. The more I talked, asking stupid questions such as, “Will the lump just dissolve itself, or should I see a plastic surgeon?” the more both he and I knew this was a communication boondoggle, and I was the principal cause. We hung up and I shuttled over to his office for a long chat.

Psychologists tell us that in any conversation, for either participant, only about half of what is communicated is actually received and understood. People just don’t listen as they should.

If we are speaking with a friend or family member, it is more likely our messages are getting through most of the time. But if the content of the conversation evolves into strong opinion or becomes tinged with emotion of any kind, you can bet messages get garbled and their meaning distorted. My guess is that discussions with strong emotional content between strangers result in less than 10 percent of the communication being understood.

Imagine then, the situation when you are faced with someone you likely do not know well (a doctor) who is telling you that you have a potentially fatal disease (talk about emotional content!). You can just about kiss communication goodbye, at least for now.

For cancer patients, interacting with their physician is a critical part of treatment. Without clear communication, nothing in the treatment plan can work well.

Sorting Out the Message

From more than 25 years of practice in clinical psychology, I’ve come to understand that messages between people are made up of content, meaning and emotion in roughly equal parts. Content is by far the easiest to decipher and, for most patients, is what is exchanged between them and their caregivers. Information is the stock-in-trade of healthcare professionals. In fact, approximately two-thirds of the time you spend with your doctor or nurse is likely focused on transfer of information.

Facts and figures are generally straightforward enough, easy to appreciate and absorb. Unless, of course, these facts and figures are relevant to a decision you are asked to make—the outcome of which could affect your life quality or even your life.

Then, this informational content begins to take on new meaning—a meaning colored by the implication this information has for you personally. The “meaning” part of the message starts to stir up feelings and emotions, most of which act a lot like static on radio or television signals. They obscure what is being said. Our emotions get in the way of our understanding, and, as I discovered years ago, you become “deaf” for a while. My favorite saying lately has been: “Apprehension always gets in the way of comprehension.”

Why does this happen? Each of us has our unique way of perceiving and processing what we see and hear in our lives. Over time, we form a distinctive style of thinking made up of our beliefs, attitudes and assumptions about the world. These elements together evolve into our characteristic “thought style,” most of which is generally not in our daily consciousness. As a result, this “style” becomes automatic, and our interpretations of the meaning we assign to our lives goes largely unnoticed. That is, until we bump up against something really important like being diagnosed with cancer. When this happens, our peculiar thought styles might prove just as malignant as a tumor cell.

Automatic thinking has several well-described features, which, if you take the time to observe, you may find occurring in your own daily experiences. Here are a few of the main offenders:

• Black-or-white thinking
  
• All-or-nothing reasoning
  
• Catastrophizing
  
• Mind reading
  
• Fortune telling
  
• Emotional reasoning

Each of these styles of thinking carries the potential to distort how we communicate and thereby confuse our efforts to understand and use information. Take the first item on the list as an example: Let’s say the person with this black-or-white thinking style was just told by the doctor they had a suspicious chest X-ray. The conversation might go something like this:

Doctor: “John, there is a small dark smudge on the X-ray of your lungs. It could be nothing, but I think we ought to take a closer look.”

John: (Thinking to himself automatically, “My God, I have cancer. That must be it!”)

“I knew there was a reason I haven’t been feeling good these past two weeks. Nobody at home believed me.”

Doctor: “We’ll schedule a CT scan for tomorrow and make sure what we’re looking at.”

John: (Thinking to himself again, “Well, here I go. Got the big C just as I thought.”)

“I do have a history of cancer in my family. Sooner or later I figured it would catch up with me.”

As you hear through John’s words, he sees his problem as cut-and-dried. It’s a sure case of cancer and could not be anything else, such as a bacterial or viral infection. John sees his world in either/or terms and puts himself under a self-imposed stress, which will rapidly degrade the quality of his life.

The black-or-white reasoning framework also casts doubt on the possibility that good things, like the list I offered at the beginning of this article, could occur. You may also be able to predict that John will begin to “catastrophize” his situation very soon, seeing only the worst outcomes and giving himself a gloomy prognosis (fortune telling), so that whatever the outcome, the process is bound to be painful.

The power of positive thinking and acquiring the techniques for mood enhancement and empowerment through self-directed learning has been a powerful adjunct to other therapies I have undertaken.

These days I “hear” much better, and, more importantly, I communicate more effectively. Life is good.